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3_Cholinesterase Inhibitors - Maggini et al.

3_Cholinesterase Inhibitors - Maggini et al. - the trial...

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PLoS Medicine | www.plosmedicine.org 0458 the trial reports as a safe and effective means of treating vascular dementia. After a pooled analysis of the two trials, the authors wrote that “the results ... are somewhat confusing,” and “further data on donepezil’s impact on executive functioning would be certainly desirable” [18,19]. At the time of writing this article, the data from these vascular dementia trials have not been considered sufficient evidence to license donepezil for treating vascular dementia. However, the positive messages contained in the published RCTs may promote the off- label use of the drug. Dementia Associated with Parkinson Disease and Dementia with Lewy Bodies A Cochrane systematic review identified only one RCT (involving 120 patients) of the efficacy of rivastigmine in patients with probable dementia with Lewy bodies [20,21]. The Cochrane reviewers concluded that the trial “showed no statistically significant difference between the two groups at 20 weeks. A possible beneficial effect on neuropsychiatric features was found only in analysis of observed cases, and may therefore be due to bias.” Hence the evidence of any benefit is currently weak [21]. Two clinical trials have investigated the effect of cholinesterase inhibitors in patients with dementia associated with Parkinson disease. The first one [22], which found a trend (not statistically significant) toward better scores on the ADAS-cog is not further discussed here because of its small size (only 22 patients were randomized to receive donepezil or placebo).
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